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Vanora

Vanora

This is part of a concerted campaign in the UK to seek support for patients suffering difficulties with drug dependence to antidepressants and benzodiazepines. Stevie Lewis has submitted a petition to the Welsh Government which compliments the petition to the Scottish Parliament which is progressing through the Petition Committee stages at the moment. Health is a devolved issue in Wales, Scotland and Northern Ireland. We are also awaiting the results of ongoing negotiations between the British Medical Association and the Department of Health in London re a helpline and website for prescription drug dependence.

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nz11

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e-Petition: Prescription drug dependence and withdrawal - recognition and support

We call on the National Assembly for Wales to urge the Welsh Government to take action to appropriately recognise and effectively support individuals affected and harmed by prescribed drug dependence and withdrawal.

This petition has been set up to raise awareness of the plight of individuals in Wales who are affected by dependence on and withdrawal from prescribed antidepressants and benzodiazepines – and specifically to ask the Welsh Government to support the BMA's UK-wide call for action to provide timely and appropriate support for individuals affected.

The term "prescription drug dependence" refers specifically to the situation where, having taken their antidepressant or benzodiazepine medication exactly as prescribed by their doctor, patients find they are unable to stop because of the debilitating withdrawal effects. It is important to note here that addiction and dependence are related but different issues. Use of the term addiction implies pleasure seeking behaviour.

Reporting of prescription drug dependence in the media continues to allude to "misuse" and "addiction" as if the patient is responsible in some way for their own harm. This is far from the truth. There is no pleasure whatsoever in finding that if you try to reduce or stop your antidepressant, you suffer a wide range of physical and emotional disturbances, that for some people can be life limiting and, tragically, even life ending. Patients need formal acknowledgement, support and guidance to help them through their withdrawal journey and this currently does not exist.

The British Medical Association has recently highlighted the issue of prescribed drug dependence. In May 2017, they wrote: "Prescribing of psychoactive drugs is a major clinical activity and a key therapeutic tool for influencing the health of patients. But often their use can lead to a patient becoming dependent or suffering withdrawal symptoms. In the absence of robust data, we do not know the true scale and extent of the problem across the UK. However, the evidence and insight presented to us by many charity and support groups shows that it is substantial. It shows us that the 'lived experience' of patients using these medications is too often associated with devastating health and social harms.

This represents a significant public health issue, one that is central to doctors' clinical role, and one that the medical profession has a clear responsibility to help address." Because the side effects, tolerance effects and withdrawal effects of these medicines are not medically recognised for what they are, when patients develop these related effects/symptoms they are often prescribed other medicines and then polypharmacy complicates the problems further.

Affected patients are finding themselves with vague diagnoses eg: 'medically unexplained symptoms' or 'functional/somatic system disorders'. These are essentially psychiatric diagnoses attributing various debilitating and disabling physical symptoms to patients' own anxiety, beliefs, etc. This has the effect of discounting, disempowering and demoralising these patients still further. If it cannot be acknowledged that patients can have sustained functional nervous system dysfunction and damage as a consequence of taking medicines 'as prescribed' (sometimes over many years), systemic medical learning and improvement is stifled and patients continue to be further harmed. Meanwhile the initial prescribing risks remain severely underestimated and misleading prescribing guidelines and 'best practice' advice is unchanged.

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nz11

nz11

Wow It is well worth the time to look at the submissions on that second link. And the comments at the bottom. This one in particular caught my attention:

Our survey of 1800 antidepressant users, the largest ever, found that one in four were addicted and 55% experienced withdrawal symptoms when trying to stop or reduce. Read, J et al. (2014). Psychiatry Research, 216, 67-73. Meanwhile the drug companies and Royal College of Psychiatry insists they are not addictive. This is a repeat of the years if denial that benzodiazepines are addictive. And antidepressants are no more effective than placebo for about 90% of people. Yet one in ten people (1 in 7 women!) are prescribed these drugs every year in UK. Antipsychotics are not addictive but cause diabetes etc and shorten life span, while beating placebo for about 20%. ADHD drugs are also problematic and yet are being increasingly used on our young children.

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As GP's time is more limited and drug companies marketing practices become more attractive, the patient is increasingly at risk - especially in relation to mental health treatments. I've seen children as young as 12 on anti-depressants - confused, struggling to make sense of their world, and now on mind-altering medication - it's not the answer and it's genuinely not safe. There are fast, effective, up-to-date therapies out there. Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way.

Jennifer Broadley

9:03 on 10 May 2017

I like her inference to pharma prescribing kickbacks ....'drug companies marketing practices become more attractive'

I think I just found my next drug sig quote:

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way.

Jennifer Broadley 2017

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nz11

Holy cow.... have a read of the Samaritan submission this is just out of control.

Samaritans is the leading suicide prevention charity in the UK and ROI. There are 19 Samaritans branches across Scotland, from Stornoway to Selkirk. As well as responding to calls, emails, text and letters, the volunteers in our branches talk to people face to face. They also offer emotional support everywhere from schools, workplaces, communities, festivals and events to prisons, hospitals, courts, custody suites, homeless shelters and food banks. This is as well as supporting the public, emergency services and others in communities facing serious trauma.As such, we responded to more than 5.7 million calls for help in 2016. This is an increase of nearly 300,000 on the previous year and over 300,000 of those were answered in Scotland. Despite this increase, our service remains available 24 hours a day, 365 days a year through the extraordinary commitment of our volunteers.

How can anyone read this and not be outraged by the unfolding iatrogenic epidemic ....

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PE1651/F Dr Peter J Gordon submission of 3 June 2017
I am writing in support of this petition. I am an NHS Consultant Psychiatrist who has worked in this specialty in Scotland for almost 25 years now. My wife has worked as a General Practitioner in Scotland over the same period. I have an interest in ethics, human rights and the medical humanities generally. One of the areas I have taken much interest in is informed consent.

I would argue that this backdrop may mean that I can add some thoughts and reflections that might help the Committee in the consideration of this particular petition.

I should make it clear that as an NHS psychiatrist I do prescribe antidepressants and other psychotropic medications. I try to do so following the best available evidence as considered within my professional understanding of each unique patient and their life circumstances.

I wish to keep this summary short as I am aware that the Committee receives a great deal of evidence. So I offer a few points of evidence that I would be willing at a future date to expand upon if that were felt to be helpful:


Antidepressant prescribing In Scotland (ISD figures) has been rising year-on-year in Scotland for at least the last ten years (this is also true of all other prescribed psychotropic medications). It is estimated that 1 in 7 Scots are now taking antidepressants and many of these in the long-term.


At a recent Parliamentary Cross Party Meeting on Mental Health and older adults an invited speaker stated that: “depression is under-recognised across all age groups” and that “maintenance treatment has a good risk-benefit ratio.”


A key opinion leader and Government advisor has previously argued that prescribing of antidepressants in Scotland is “conservative” and “appropriate”. David Healy, Serotonin and depression, BMJ 2015; 350:h1771


Many of the key opinion leaders “educating” doctors prescribing antidepressants in Scotland appear to have significant financial interests with the makers of these medications. Across the UK, £340 million was paid by the pharmaceutical industry in the last recorded year to healthcare workers and academics for such “promotional activities”.


“Informed Consent” will not be possible if the information that doctors base prescribing on follows such promotion rather than independent, and more objective, continuing medical education. This issue is now at the fore of the Mesh Inquiry.

A few questions that need to be considered:
 When patients are prescribed antidepressants are they informed that as many as 1 in 2 will be taking antidepressants long-term?
 Are patients informed that there may be a significant risk of pharmacological dependence on antidepressants?
 Do patients know that their experience of antidepressants may be considered less valid than the experts (who may have been paid by the pharmaceutical industry) who educate other doctors (who may be unaware of this potential financial bias)?

Summary:
My view is that antidepressants are over-prescribed in Scotland.My view is that patients have not been properly informed of benefits and risks.
My view is that appropriate prescribing has not been realised due to a number of factors: the lack of access to psychological therapies or other meaningful supports; the wide promotion of antidepressants where marketing is routinely conflated with education; and a culture of increasing medicalisation generally.

I would suggest that this petition might be considered in light of the Chief Medical Officer’s Realistic Medicine campaign.

It is time for balance to be re-established between “medical paternalism” and the valued, vital and real-world experiences of patients who are taking medications like antidepressants.

I am particularly disappointed in my own College, the Royal College of Psychiatrists for not making greater effort to facilitate such balance. Without such, I fear more harm will result from inappropriate and costly prescribing in NHS Scotland.

Finally, due to widespread “off-label” promotion of antidepressants in Scotland, patients may experience withdrawal syndromes which can be most severe and precipitate mental states far more serious than the mental state for which they may have originally been prescribed.

I would urge the committee to consider this petition most carefully and to seek balance in their appreciation of where expertise rests.

.........................//.......................

Did Healy really say this:

A key opinion leader and Government advisor has previously argued that prescribing of antidepressants in Scotland is “conservative” and “appropriate”. David Healy, Serotonin and depression, BMJ 2015; 350:h1771

Surely of all people Healy didn't say this???!??

Please someone tell me Healy didn't say this.

Later......

trying to track down that Healy article...

Found this Healy statement ...:

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world.

Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population.These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin.

Serotonin and depression

The serotonin reuptake inhibiting (SSRI) group of drugs came on stream in the late 1980s, nearly two decades after first being mooted. The delay centred on finding an indication. They did not have hoped for lucrative antihypertensive or antiobesity profiles. A 1960s idea that serotonin concentrations might be lowered in depression1 had been rejected,2 and in clinical trials the SSRIs lost out to the older tricyclic antidepressants as a treatment for severe depression (melancholia).345

When concerns emerged about tranquilliser dependence in the early 1980s, an attempt was made to supplant benzodiazepines with a serotonergic drug, buspirone, marketed as a non-dependence producing anxiolytic. This flopped.6 The lessons seemed to be that patients expected tranquillisers to have an immediate effect and doctors expected them to produce dependence. It was not possible to detoxify the tranquilliser brand.

Instead, drug companies marketed SSRIs for depression, even though they were weaker than older tricyclic antidepressants, and sold the idea that depression was the deeper illness behind the superficial manifestations of anxiety. The approach was an astonishing success, central to which was the notion that SSRIs restored serotonin levels to normal, a notion that later transmuted into the idea that they remedied a chemical imbalance. The tricyclics did not have a comparable narrative.

Serotonin myth

In the 1990s, no academic could sell a message about lowered serotonin. There was no correlation between serotonin reuptake inhibiting potency and antidepressant efficacy. No one knew if SSRIs raised or lowered serotonin levels; they still don’t know. There was no evidence that treatment corrected anything.7

The role of persuading people to restore their serotonin levels to “normal” fell to the newly obligatory patient representatives and patient groups. The lowered serotonin story took root in the public domain rather than in psychopharmacology. This public serotonin was like Freud’s notion of libido—vague, amorphous, and incapable of exploration—a piece of biobabble.8 If researchers used this language it was in the form of a symbol referring to some physiological abnormality that most still presume will be found to underpin melancholia—although not necessarily primary care “depression.”

The myth co-opted the complementary health market. Materials from this source routinely encourage people to eat foods or engage in activities that will enhance their serotonin levels and in so doing they confirm the validity of using an antidepressant.9 The myth co-opts psychologists and others, who for instance attempt to explain the evolutionary importance of depression in terms of the function of the serotonin system.10 Journals and publishers take books and articles expounding such theories because of a misconception that lowered serotonin levels in depression are an established fact, and in so doing they sell antidepressants.

Above all the myth co-opted doctors and patients. For doctors it provided an easy short hand for communication with patients. For patients, the idea of correcting an abnormality has a moral force that can be expected to overcome the scruples some might have had about taking a tranquilliser, especially when packaged in the appealing form that distress is not a weakness.

Costly distraction

Meanwhile more effective and less costly treatments were marginalised. The success of the SSRIs pushed older tricyclic antidepressants out of the market. This is a problem because SSRIs have never been shown to work for the depressions associated with a greatly increased risk of suicide (melancholia). The nervous states that SSRIs do treat are not associated with increased risk of suicide.11 The focus on SSRIs also coincided with the abandonment of the pursuit of research into established biological disturbances linked to melancholia (raised cortisol); the SSRIs are ineffective in mood disorders with raised cortisol.12

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population.1314 These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin.

Meanwhile studies suggesting that ketamine, a drug acting on glutamate systems, is a more effective antidepressant than SSRIs for melancholia cast doubt on the link between serotonin and depression.151617

Serotonin is not irrelevant. Just as with noradrenaline, dopamine, and other neurotransmitters, we can expect it to vary among individuals and expect some correlation with temperament and personality.18 There were pointers to a dimensional role for serotonin from the 1970s onwards, with research correlating lowered serotonin metabolite levels with impulsivity leading to suicidality, aggression, and alcoholism.19 As with the eclipse of cortisol, this research strand also ran into the sand; SSRIs lower serotonin metabolite levels in at least some people, and they are particularly ineffective in patient groups characterised by impulsivity (those with borderline personality traits).20

This history raises a question about the weight doctors and others put on biological and epidemiological plausibility. Does a plausible (but mythical) account of biology and treatment let everyone put aside clinical trial data that show no evidence of lives saved or restored function? Do clinical trial data marketed as evidence of effectiveness make it easier to adopt a mythical account of biology? There are no published studies on this topic.

These questions are important. In other areas of life the products we use, from computers to microwaves, improve year on year, but this is not the case for medicines, where this year’s treatments may achieve blockbuster sales despite being less effective and less safe than yesterday’s models. The emerging sciences of the brain offer enormous scope to deploy any amount of neurobabble.21 We need to understand the language we use. Until then, so long, and thanks for all the serotonin.

Notes

Cite this as:BMJ 2015;350:h1771

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Vanora

Vanora

I can see where there might be some confusion. Dr Peter Gordon hasn't named the government advisor in question but references David Healy to show how flawed the advice to the Scottish government is. He goes on to say opinion leaders have vested interests. I hope that clarifies things for you nz11.

We had some very good responses to our petition to the Scottish parliament and some of the more notable names have signed - Professor Peter Gotzsche, Professor John Read, Dr James Davies, Luke Montague, Katinka Newman, Dr Terry Lynch and Professor David Healy.........and David Healy has signed the Welsh petition. It would be fantastic if something like this could happen where you are in New Zealand nz11. I'd be more than happy to sign.

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Vanora

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The petition will continue to collect signatures until the 28th November so if you haven't already signed please take the opportunity now and a big thank you to everyone who has already given their support. Every signature counts!

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The petition has now closed. For anyone interested it is scheduled for its first committee consideration on the 5th December. Will post again when I have further information. Thanks to all who took the time to sign.

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Dear Mr Rowlands
Ten per cent of the population of Wales takes an antidepressant on prescription. Of those between 80 and 90% are on treatment for more than a year - many for over a decade. When the latest antidepressants were introduced around 1990 the recommendation was that they would be used for 3-6 months. Apologists for the drugs say treatment for over a year is a good thing. Its not. Its caused by dependence and it continues because so many people attempting to stop feel so bad they continue with treatment.
The marketing of these drugs targeted women of child-bearing years, although companies knew from the start the drugs were likely to lead to dependence and to birth defects, from major organ defects to behaviour abnormalities such as autistic spectrum disorder.
While treatments can be helpful, the evidence for true benefits when used in general practice is missing. The drugs are now the most commonly used medications by women in their teens and early twenties and in these age groups there is no evidence for benefit. Because of the dependence the drugs cause, many young women are trapped into pregnancies in which their unborn babies are exposed to a teratogen because stopping is so difficult. There is no benefit to the woman for the most part or her child in any instance.
For all too many, women in particular, antidepressants turn out to be a gateway drug, into treatment with mood-stabilizers and other drugs or for antidepressant induced alcoholism or antidepressant induced osteoporosis or other conditions.
There is a pressing need to understand antidepressant dependence - how to avoid it and how best to manage it. This is a more serious problem than benzodiazepine dependence.

David Healy MD FRCPsych Professor of Psychiatry

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The David Healy letter is excellent, I feel Stevie Lewis who is behind this petition has excelled herself. We've been very lucky to have Marion Brown of Recovery & Renewal as our petitioner in Scotland and it is largely down to her efforts that our petition there has got this far, most of us still being too unwell though we did submit letters. I understand your concerns over anonymity nz but if you do decide to start your own petition and I hope you do, you can count on my signature and I will post it on my FB campaign group page (Prescribed Harm UK) for them to promote and sign. It's all done on-line and is relatively straight forward.

I would suggest that you try and get the media in your country interested in your petition, it helps to get some publicity as it gets the attention of the public as well as the politicians. Good luck to you and I hope you are inspired to take that next step.

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On closer inspection you are right they do appear to be referring to written petitions as opposed to the on-line variety but I note that they do talk about on-line petitions elsewhere though they don't go into details about how you start one.

There is a telephone number for the Clerk of the House of Representatives (04) 817 9999 perhaps they could help. We've had a lot of guidance from clerks at the Scottish Parliament, they've been very helpful. There is also an email address - Petitions@parliament.govt.nz - and for Copies of a Guide to "Making a Submission to a Parliamentary Select Committee" - www.parliament.nz. I hope that's of help to you nz. You would probably benefit from having someone to collaborate with because I appreciate this is quite a task for one person. I know that revealing you identity wouldn't be an easy decision to take.

You may have seen this video from Ian Singleton a withdrawal adviser at the Bristol Tranquilliser Project but he is clear that antidepressant withdrawal can be as prolonged if not more so than a benzo withdrawal. Given our prescribing rates for antidepressants I can see this being an ongoing problem in the future. Take care.

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Despite the very limited time given to the Welsh petition this morning the Committee agreed to support the petitioner Stevie Lewis's recommendations and write to the Cabinet Secretary for Health and Social Security for their views. The committee agreed to get input from the government on the target reduction of antidepressants and on a support and counselling services which covers all of Wales for people with prescribed drug dependence. I think we have received a good result for all the hard work of Stevie Lewis so far.

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A brief discussion on the Welsh petition was held yesterday the 23rd January by the petitions committee at the Welsh Assembly. They decided to seek further evidence from the British Medical Association, local Health Boards, the Health and Social Care Committee, and (this is the best part) from the individuals affected. The issue of prescribed drug dependence and withdrawal is still very much on the agenda!